Provider Demographics
NPI:1902820442
Name:PRUDEN, BRITTANIE NA (LMP)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:NA
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BRITTANIE
Other - Middle Name:NA
Other - Last Name:PRUDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:821 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4225
Mailing Address - Country:US
Mailing Address - Phone:253-833-1833
Mailing Address - Fax:253-833-4642
Practice Address - Street 1:821 HARVEY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4225
Practice Address - Country:US
Practice Address - Phone:253-833-1833
Practice Address - Fax:253-833-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist